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Illinois rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $2,290.87 / $7,762.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,513.56 / $2,884.03
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $295.12 / $1,230.27
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $851.14 / $2,630.27